Coders, billers, and physicians are much more knowledgeable now than when we started working with practices over 25 years ago. There has also been a steady increase in automation throughout the billing, documentation, and coding process. Despite the increase in knowledge and increased use of automation, we continue to see many costly billing, documentation, and coding mistakes.
In this article, we will review mistakes made throughout these processes and what you can do to prevent them.
Billing errors common
Access Project, a health care advocacy group, has determined that 80% of all medical bills contained mistakes, according to an Aug. 2, 2017 Medical Economics article, “Easy tips for physicians to reduce billing errors.” Kaiser Health reported that $68 billion is lost to health care spending because of medical billing mistakes.
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Billing rules and payer requirements have become more and more detailed and restrictive. The margins within which physician practices operate continue to decrease. Electronic medical records, practice management systems, and other automated tools used by practices require too much time and manual effort to use correctly. New quality and value programs are requiring more time and effort with little visible benefit to patient care or outcomes.
The health care field is in many ways no different than the broader market. As the system becomes more complex, practices have to continue to innovate, educate, and improve internal systems to keep up with both the clinical and administrative demands of the system. Like it or not, human interface is a key component. Input into the system must be accurate, and the outcome of the automated processes must be monitored to ensure that the information is correct. “Garbage-in/garbage-out” is applicable to today’s medical billing process.
In our work with practices around the country, we see mistakes being made in every step of the complicated and detailed process. Collecting patient data, identifying the services provided, accurate service documentation, determining the correct codes, submitting the claim, and accurate follow-through are a few of the common failure points in the process.
Today’s billing process requires a team effort in every practice. Many of you are familiar with what we’ve called the “Wheel of Fortune” detailing the 18 to 20 steps that are required to accurately code, bill, and collect.